Clinical Briefs

VERNA ROSE

Am Fam Physician. 1998 Feb 1;57(3):569-570.

Routine Ultrasound in Low-Risk Pregnancy

Because as many as 70 percent of pregnant women in the United States undergo ultrasound examination at various times during gestation, the American College of Obstetricians and Gynecologists (ACOG) undertook an analysis of the literature to determine the benefit or lack of benefit of routine ultrasound in women with low-risk pregnancy who do not already have an indication for ultrasound use. Results of the evaluation were published as a practice pattern (ACOG Practice Pattern No. 5, August 1997). The report includes a discussion of the purpose, the objectives and methods of the evaluation, a discussion of the results of the literature review and a discussion of cost considerations. The following summary points have been excerpted from the practice pattern:

The specificity of a fetal anatomic survey in detecting fetal anomalies can be expected to exceed 99 percent.

The sensitivity in detecting fetal anomalies cannot be estimated with precision.

It is not known if an improvement in the survival of fetuses with life-threatening anomalies can be expected from routine ultrasound in low-risk pregnancy.

In women with low-risk pregnancies, neither a reduction in perinatal morbidity and mortality nor a lower rate of unnecessary interventions can be expected from routine diagnostic ultrasound. Thus, ACOG believes that ultrasound should be performed for specific indications in low-risk pregnancy.

Booklet on Coping with Rosacea

A new booklet titled “Coping with Rosacea: Tips on Lifestyle Management,” has been published by the National Rosacea Society. The booklet is designed to help patients with rosacea moderate or eliminate lifestyle and environmental factors that may aggravate rosacea in their individual cases. Other tips relate to proper skin care and cleansing techniques, reducing stress and managing the psychologic and social aspects of the disease.

For a free copy of “Coping with Rosacea,” write the National Rosacea Society, 800 S. Northwest Highway, Suite 200, Barrington, IL 60010, or call 888-NO-BLUSH. Information and materials are also available on the NRS Web site (http://www.rosacea.org) or by E-mail (rosaceas@aol.com).

IOM Report on Halcion

The sleeping pill Halcion is safe and effective when used as recommended on the label approved by the U.S. Food and Drug Administration (FDA), according to a new report from a committee of the Institute of Medicine (IOM). The committee notes, however, that more research is needed to determine the long-term effects of the drug, which often is prescribed for longer periods and at higher doses than recommended on the label. The committee urges the FDA to establish an independent task force to address the prescribing patterns and use of all hypnotic drugs, including Halcion. In addition to studying the long-term effects of Halcion, the IOM recommends that the FDA aggressively confront the health problems that may result from the use of prescription drugs beyond labeling recommendations.

A copy of the report on Halcion is available for $36 plus shipping charges from the National Academy Press by calling 202-334-3313 or 800-624-6242.

Breast Feeding and the Use of Human Milk

The American Academy of Pediatrics (AAP) has always been an advocate of breast feeding as the optimal form of nutrition for infants. New recommendations from the AAP further support human milk as the preferred feeding for the first year of life and longer as the optimal situation for both mother and child. The recommendations were published in the December 1997 issue of Pediatrics.

Some of the suggested breast-feeding practices include the following:

Breast feed as soon as possible after birth, preferably within the first hour of life.

Breast feed on demand in response to signs of hunger, such as increased alertness or activity, mouthing or rooting, instead of using crying as an indicator to nurse. Newborns should be nursed about eight to 12 times every 24 hours until full, usually 10 to 15 minutes on each breast. In the early weeks after birth, nondemanding infants should be aroused to feed if four hours have elapsed since the last nursing.

Refrain from giving supplements such as formula or water to breast-feeding newborns, unless medically indicated.

All breast-feeding mothers and their newborns should be seen when the newborn is two to four days of age, if they were discharged less than 48 hours after delivery. Breast feeding should be observed and evaluated for evidence of successful breast-feeding behavior. The infant should be assessed for jaundice, adequate hydration and age-appropriate elimination patterns by five to seven days of age. All newborns should be seen by one month of age.

Breast feed exclusively for about the first six months after birth, after which time iron-enriched solid foods can be added to complement the breast milk diet.

The AAP believes that breast feeding ensures the best possible health as well as the best developmental and psychosocial outcomes for infants. Extensive evidence justifies that physicians should enthusiastically support and promote the practice of breast feeding.

NIMH Web Site on Anxiety Disorders

The National Institute of Mental Health (NIMH) has launched a Web site with information on anxiety disorders. The new online service provides the latest information about the symptoms, diagnosis and treatment of panic disorder, obsessive-compulsive disorder, post-traumatic stress syndrome, phobias and generalized anxiety disorder. Also available is information on national mental health organizations, self-help groups and a resource list that includes journal articles, books and audiovisual materials for consumers and medical and mental health professionals. The Web address is http://www.nimh.nih.gov/anxiety. The Web site is one component of NIMH's Anxiety Disorders Education Program (ADEP). In addition to the Web site, ADEP provides free information about these illnesses to the general public and medical and mental health professionals through a toll-free number (88-88-ANXIETY).

HPV Testing by the ThinPrep Pap Test

The U.S. Food and Drug Administration (FDA) has approved testing for human papillomavirus (HPV) directly from the ThinPrep Pap Test collection vial. The manufacturer of the ThinPrep Pap Test reports that the option of adding HPV DNA testing in combination with the ThinPrep Pap test has the potential for substantial cost savings through earlier detection and less costly management of borderline cervical abnormalities. The fluid-based ThinPrep Pap test is currently the only FDA-approved screening method that provides testing for HPV.

Snowboarder's Fracture

Snowboarding, one of the fastest growing sports in America, is associated with a common ankle fracture that is often mistaken for a simple sprain and can cause significant disability if overlooked and left untreated, according to a statement from the American Orthopaedic Foot and Ankle Society (AOFAS). The statement says that 15 percent of all injuries to the ankle sustained by persons who are snow-boarding result in a fracture to the uppermost bone of the foot, the talus. These fractures are often misdiagnosed as sprains, because they are poorly visible on plain radiographs and require imaging by computed tomography to be clearly seen. AOFAS states that aggressive treatment would include surgical repair of the damaged joint, if necessary.

For more information on this injury and other issues, contact the AOFAS, 1216 Pine St., Ste. 201, Seattle, WA 98101; telephone: 800-235-4855 or 206-223-1120; fax: 206-223-1178. Patient information is also available on the Internet (http://www.aofas.org).